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technique of behaviour modification

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					   Techniques of
behavior modification




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1.INTRODUCTION
2.DEFINITION
3.TECHNIQUES:

           -BEHAVIOR SHAPING
           -DESENSITIZATION
           -TELL ,SHOW ,DO
           -MODELLING
           -CONTINGENCY MANAGMENT
           -RETRAINING/RECONDITIONING

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       INTRODUCTION

•THE TERM BEHAVIOUR MODIFICATION
 EMERGES FROM EARLY WORK BY
 SKINNER(1953),HONIG(1966),REESE(1966),
 & GRUNBAUM(1966)

•THE CONCPT IS BASED ON ESTABLISHMENT
 OF COMPETENT BEHAVIORAL ENGINEERING
 SKILLS TO BRING ABOUT CHANGE IN CHILD
 BEHAVIOR.
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 DEFINITION:BEHAVIOR MODIFICATION IS
 DEFINED AS ” THE ATTEMPT TO ALTER
 HUMAN BEHAVIOR & EMOTION IN A
 BENEFICIAL MANNER ACCORDING TO THE
 LAWS OF MODERN LEARNING THEORY”


TECHNIQUES:
1.BEHAVIOR SHAPING : IS THE PROCEDURE
WHICH SLOWLY DEVELOPS BEHAVIOR BY
REINFORCING A SUCCESSIVE APPROXIMATION
OF THE DESIRED BEHAVIOR UNTIL THE
DESIRED BEHAVIOR COMES INTO BEING
                                         4
-IT IS BASED ON STIMULUS RESPONSE THEORY
-IT IS STEP BY STEP PROCEDURE IN WHICH THE
 DENTIST IS TEACHING THE CHILD
-IT IS NECESSARY TO MAKE ALL EXPLANATIONS
 AT THE CHILD’S LEVEL OF UNDERSTANDING &
 DIVIDE THE EXPLANATION FOR THE PROCEDURE
-THE ANOTHER THEORY IS “CONCEPT OF EXPOSURE
 THERAPY“ SUGGESTED BY HOLST
THE SUBJECTS ARE EXPOSED BY STEPS TO
POTENTIAL ANXIETY PROVOKING INSTRUMENTS &
PROCEDURES WHERE EACH STEPS CREAT A
 MODERATE INCREASE IN STRESS & FEAR & THEY
ARE KEPT IN THIS EXPOSURE SITUATION UNTIL
 THEY EXPERIENCE A DECREASE IN THEIR     5

FEARFULL REACTIONS
 If the exposure is interrupted
 before the fear decreases, the
 Level of fear increases and
  creates a feeling of defeat &
 Lack of coopertion
  Indications:
- Children who demonstrate sufficient cooperation to
  establish communication
  Procedure:
- State general task/goal to child at outset
- explain necessity for the procedure
- divide explanation for the procedure
- make all explanation at a child`s level of understanding
- use successive approximation (T.S.D.)
- reinforce appropriate behavior                        6

- disregard minor inappropriate behavior
2.DESENSITISATION:
MASSERMAN(1943),JOSEPHWOLPE(1969)
-MOST EFFECTIVE METHOD OF REDUCING ANXIETY OR
MALADAPTIVE BEHAVIOR
-DESENSITISATION IS ACCOMPLISED BY TEACHING THE
CHILD COMPETING RESPONSE SUCH AS:
   - TRAINING TO INDUCE A STATE OF DEEP MUSCLE
RELAXSATION
   - CONSTUCTING A HIERARCHY OF FEAR PRODUCING
STIMULI
   -INTRODUCING EACH STIMULUS IN HIERARCHY TO
RELAXED PATIENT STARTING WITH THE STIMULUS WHICH
CAUSES LEAST FEAR
 SYSTEMIC DESENSITISATION CAUSES RECIPROCAL
INHIBITION & IS EFFECTIVE BECAUSE PATIENT LEARNS TO
SUBSTITUTE AN APROPRIATE & ADAPTIVE EMOTIONAL
RESPONSE                                            7
 SYSTEMIC DESENSITISATION CAUSES RECIPROCAL
INHIBITION & IS EFFECTIVE BECAUSE PATIENT LEARNS TO
SUBSTITUTE AN APROPRIATE & ADAPTIVE EMOTIONAL
RESPONSE
3.TELL,SHOW,DO:
   ADDLESTON(1959)
  THE METHOD INVOLVES VERBAL EXPLANATION OF THE
PROCEDURE & PHRASES APPROPRIATE TO THE
DEVELOPMENTAL LEVEL OF THE PATIENT
        e.g.– radiograph-a photograph using a special camera
             mouth mirror –tooth counter
             L.A.-putting tooth to sleep
             rubber dam-raincoat
             handpiece-produces shower
             matrix band-queen’s /king’s crown
DEMONSTRATION OF VISUAL AUDITORY,OLFACTORY &
TECTILE ASPECT OF THE PROCEDURE & THEN WITHOUT
DEVIATING FROM THE EXPLANATION & DEMONSTRATION 8,
COMPLETION OF PROCEDURE
9
10
INDICATIONS:
           - FIRST VISIT
           - SUBSEQUENT VISIT WHEN
             INTRODUCING NEW DENTAL
             PROCEDURE
           - FEAR FULL CHILD
           - APPREHANSIVE CHILD
ANCHORING:
          THE TERM ANCHORING USED BY
NUROLINGUISTIC PROGRAMERS TO DESCRIBE
HOW TO CHANGE IN EMOTIONAL STATE CAN BE
BROUGHT ABOUT BY EXTERNAL REINFORCEMENT
          e.g.– squeezing the shoulder
              - use of double pat on shoulder & say
                                               11


                “good job”
4.MODELLING/IMITATION:
 ALBERT BANDURA(1969)
- IT INVOLVES ALLOWING A PATIENT TO OBSERVE ONE OR
  MORE INDIVIDUALES(MODELS) WHO DEMONSTRATE A
  POSITIVE BEHAVIOR IN A PERTICULAR SITUATIONS
- THEREFOR THE PATIENT FREQUENTLY INTIMATE THE
  MODEL’S BEHAVIOR WHEN PLACED IN A SIMILAR SITUATION
- MODELLING CAN BE DONE BY - LIVE MODELS,FILM MODELS,
  POSTERS, AUDIOVISUAL AIDS

 STEPS IN MODELLING:
  1.CHILD’S ATTENTION IS OBTAINED
  2.THE DESIRED BEHAIVOR IS MODELLED
  3.PHYSICAL GUIDENCE MAY BE GIVEN TO MODELLED
    THE BEHAVIOR
  4. REINFORCEMENT OF THE BEHAVIOR
                                                 12
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A.POSITIVE REINFORCEMENT:
 IS ONE WHOSE CONTINGENT PRESENTATION
 INCREASES THE FREQUENCY OF BEHAVIOR
B.NEGATIVE REINFORCEMENT:
  IS ONE WHOSE CONTINGENT WITHDRAWL
 INCREASES THE FREQUENCY OF BEHAVIOR

TYPES OF REINFORCEMENTS:
1. SOCIAL: PRAISE,POSITIVE FACIAL EXPRESSION,
    PHYSICAL CONTACT BY SHAKING HANDS,
    HOLDING HANDS & PATTING SHOULDER/BACK
  - SOCIAL REINFORCES ARE THE MOST EFFECTIVE
    ONES AS WITH THEIR USE ANXIOUS PATIENTS
    CAN BE REASSURED,COOPERATIVE PATIENTS
    CAN BE ENCOURAGED & MOTIVATED         14
EFFECTIVE WHEN-
- OBSERVER IN A STATE OF AROUSAL
- WHEN THE MODEL HAS RELATIVELY MORE
STATUS AND PRESTIGE
- WHEN MODELLING TECHNIQUE SEEMS TO
IMPROVE BEHAVIOR OF APPREHENSIVE CHILD
- NO ADDITIONAL EQUIPMENTS REQUIRED FOR
LIVE MODELLING

5.CONTINGENCY MANAGEMENT-
- METHOD OF MODIFYING THE BEHAVIOR OF
  CHILDREN BY PRESENTATION OR WITHDRAWAL
  OF REINFORCES
                                          15
2.MATERIAL : MAY BE GIVEN IN THE FORM OF TOYS
   GAMES etc.
3. ACTIVITY : INVOLVING THE CHILD IN SOME
  ACTIVITY LIKE WATCHING A T.V. SHOW,SPECIAL
  PROGRAMMES WITH HIM




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CONTINGENT ESCAPE
ALLOWING THE CHILD TO STOP TREATMENT GIVES
 HIM A SENSE OF CONTROL
e.g.: RAISING HAND WHEN HE WANTS TO STOP
    -TELL THE CHILD THAT YOU WILL NEED HIM TO LET YOU
WORK ON HIS TEETH FOR A COUNT OF 10 & THEN STOP &
ALLOW HIM TO REST FOR A WHILE                      17
6.RETRAINING /RECONDITIONING:
        SIMILAR TO BEHAVIOR SHAPING DESIGNED TO
FABRICATE POSITIVE VALUES TO REPLACE THE NEGATIVE
BEHAVIOR THAT HAS DEVELOPED
 -INDICATIONS:
     THE CHILD WHO HAS HAD A PRIVIOUSLY POOR DENTAL
 EXPERIENCE OR WHO DISPLAY A NEGATIVE BEHAVIOR FOR
OTHER REASONS
-- IF THE ORIGINAL STIMULUS & THE NEW ONE ARE VERY
SIMILAR, THIS I S KNOWN AS A STIMULUS GENRALISATION
-- IF THE CHILD IS ABEL TO DIFFERENTIATE THEN
INTERPERSONAL RELATIONS BECOME MORE SPECIFIC
 THIS ABILITY IS REFERRED AS DISCRIMINATION
-- RESPONSES THAT GO UNREWARDED OR ARE PUNISHED
BECOME WEAKER & WILL EVENTULLY DISAPPEAR THIS
 TYPE OF BEHAVIOR CHANGE IS REFERRED AS RESPONSE
EXTINCTION                                       18
    3 APPROACHES FOR
    RETRAINING/RECONDITIONING
1. AVOIDENCE:the students has moved on
    an entirely different treatment track.
2. DEPHASIS & SUBSTITIONS:
   The effective use of these tools will
    require emphasis involvement &
    understanding between the operator &
    child
3.DISTRACTION:
It may in the form of story telling or the use
    of audio visual aids.

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REFERENCES:
1. TEXTBOOK OF PEDODONTICS BY
 SHOBHA TANDON
2.TEXTBOOK OF PEDIATRIC DENTISTRY BY
 S.G. DAMLE
3.FUNDAMENTALS OF PEDIATRIC DENTISTRY
 BY
 RICHARD J. MATHEWSON
 ROBERT E. PRIMOSCH
4.PEDIATRIC DENTISTRY - A CLINICAL
 APPROACH
 GORAN KOCH
 SVEN POULSEN

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